title: Open surgical management of complications from indwelling radial artery catheters.
abstract: BACKGROUND
  Cannulation of the radial artery is frequently performed for invasive hemodynamic monitoring. Complications arising from indwelling catheters have been described in small case series; however, their surgical management is not well described. Understanding the presentation and management of such complications is imperative to offer optimal treatment, particularly because the radial artery is increasingly accessed for percutaneous coronary interventions.
  
  
  METHODS
  We conducted a retrospective review to identify patients who underwent surgical intervention for complications arising from indwelling radial artery catheters from 1997 to 2011.
  
  
  RESULTS
  We identified 30 patients who developed complications requiring surgical intervention. These complications were categorized into ischemic and nonischemic, with 15 patients identified in each cohort. All patients presenting with clinical hand or digital ischemia underwent thrombectomy and revascularization. Complications in the nonischemic group included three patients with deep abscesses with concomitant arterial thrombosis, two with deep abscesses alone, and 10 with pseudoaneurysms. Treatment strategy in this group varied with the presenting pathology. Among the entire case series, three patients required reintervention after the initial surgery, all in individuals initially presenting with ischemia who developed recurrent thrombosis of the radial artery. There were no digital or hand amputations in this series. However, the overall in-hospital mortality in these patients was 37%, reflecting the severity of illness in this patient cohort. Three patients who were positive for heparin-induced thrombocytopenia antibody had 100% mortality compared with those who were negative (P = .04, Fisher exact test). In-hospital mortality was higher in patients presenting with initial ischemia than in those with nonischemic complications (53% vs 20%; P = .06). Among 10 patients who presented with pseudoaneurysms, five (50%) were septic at presentation with positive blood cultures, and six (60%) had positive operating room cultures. Staphylococcus aureus was identified as the causative organism in all of these patients.
  
  
  CONCLUSIONS
  Complications of radial artery cannulation requiring surgical intervention can represent infectious and ischemic sequelae and have the potential to result in major morbidity, including digital or hand amputation and sepsis, or death. Although surgical treatment is successful and often required in these patients to treat severe hand ischemia, hemorrhage, or vascular infection, these complications tend to occur in critically ill hospitalized patients with an extremely high mortality. This must be taken into consideration when planning surgical intervention in this patient cohort. Finally, radial arterial cannulation sites should not be overlooked when searching for occult septic sources in critically ill patients.
authors.affiliation: Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York, NY.
authors.forename: Karan
authors.initials: K
authors.lastname: Garg
authors.forename: Brittny Williams
authors.initials: BW
authors.lastname: Howell
authors.forename: Stephanie S
authors.initials: SS
authors.lastname: Saltzberg
authors.forename: Todd L
authors.initials: TL
authors.lastname: Berland
authors.forename: Firas F
authors.initials: FF
authors.lastname: Mussa
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Maldonado
authors.forename: Caron B
authors.initials: CB
authors.lastname: Rockman
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000209:etiology / Q000601:surgery; D000785:Aneurysm, Infected / Q000209:etiology / Q000601:surgery; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D005385:Fingers / Q000098:blood supply; D006225:Hand / Q000098:blood supply*; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D017131:Thrombectomy; D013927:Thrombosis / Q000209:etiology / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D062666:Vascular Access Devices / Q000009:adverse effects*; D014652:Vascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D014656:Vascular Surgical Procedures